MEDICARE: GABRIELA C OCHOA PEER SUPPORT WORKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist		NM
2	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1558820043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA C OCHOA PEER SUPPORT WORKER

Provider Business Mailing Address
First Line	:	3465 MCNUTT RD
Second Line	:
City	:	SUNLAND PARK
State	:	NM
Zip	:	88063-9056
Country	:	US
Telephone Number	:	575-915-1338
Fax Number	:	575-915-1819

Provider Business Practice Location Address
First Line	:	2801 MISSOURI AVE STE 38
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-9151
Country	:	US
Telephone Number	:	575-636-2550
Fax Number	:	575-915-1644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	06/24/2021

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